Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series
Abstract Background Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-02-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02564-7 |
| _version_ | 1797273328696688640 |
|---|---|
| author | Audrey Qi Xin Chia Apoorva Gogna Angela Maria Takano Pena Vishnu Vemula Sri Sai Sivanathan Chandramohan Shaun Ju Min Xavier Chan Boon-Hean Ong |
| author_facet | Audrey Qi Xin Chia Apoorva Gogna Angela Maria Takano Pena Vishnu Vemula Sri Sai Sivanathan Chandramohan Shaun Ju Min Xavier Chan Boon-Hean Ong |
| author_sort | Audrey Qi Xin Chia |
| collection | DOAJ |
| description | Abstract Background Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. Methods Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. Results 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). Conclusions We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure. |
| first_indexed | 2024-03-07T14:41:52Z |
| format | Article |
| id | doaj.art-96a411531cfe40bdb0c6b34ba2dc11ce |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-07T14:41:52Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-96a411531cfe40bdb0c6b34ba2dc11ce2024-03-05T20:18:45ZengBMCJournal of Cardiothoracic Surgery1749-80902024-02-0119111410.1186/s13019-024-02564-7Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case seriesAudrey Qi Xin Chia0Apoorva Gogna1Angela Maria Takano Pena2Vishnu Vemula Sri Sai3Sivanathan Chandramohan4Shaun Ju Min Xavier Chan5Boon-Hean Ong6Department of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Anatomical Pathology, Singapore General HospitalLee Kong Chian School of Medicine, Nanyang Technological UniversityDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Cardiothoracic Surgery, National Heart Centre SingaporeAbstract Background Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. Methods Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. Results 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). Conclusions We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.https://doi.org/10.1186/s13019-024-02564-7VATSSublobar resectionNodule localizationCone-beam computed tomographyHybrid operating room |
| spellingShingle | Audrey Qi Xin Chia Apoorva Gogna Angela Maria Takano Pena Vishnu Vemula Sri Sai Sivanathan Chandramohan Shaun Ju Min Xavier Chan Boon-Hean Ong Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series Journal of Cardiothoracic Surgery VATS Sublobar resection Nodule localization Cone-beam computed tomography Hybrid operating room |
| title | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_full | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_fullStr | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_full_unstemmed | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_short | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_sort | hybrid operating room with ceiling mounted imaging system assisted pre operative and intra operative lung nodule localization for thoracoscopic resections a 5 year case series |
| topic | VATS Sublobar resection Nodule localization Cone-beam computed tomography Hybrid operating room |
| url | https://doi.org/10.1186/s13019-024-02564-7 |
| work_keys_str_mv | AT audreyqixinchia hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT apoorvagogna hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT angelamariatakanopena hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT vishnuvemulasrisai hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT sivanathanchandramohan hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT shaunjuminxavierchan hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries AT boonheanong hybridoperatingroomwithceilingmountedimagingsystemassistedpreoperativeandintraoperativelungnodulelocalizationforthoracoscopicresectionsa5yearcaseseries |